5 cbc with slide review new - constant...
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CBC with Slide Review
An interpretation of analyzer results and the microscopic examination
MELISSA BRAVERMAN, CVT
VETERINARY DIAGNOSTIC LABORATORY
VETERINARY SPECIALTY CENTER
COMPLETE CBC•Analyzer results
•Slide review�Platelets
�WBC differential
�WBC morphology
�RBC morphology
ANALYZERS
• Human error
• Large variation in animal blood cells
compared to humans
• Feline platelets can be normally 2x
the size of other mammals platelets
and therefore are often mistaken for
RBCs
ANALYZER RBC INDICESHGB – Hemoglobin
HCT – Hematocrit
MCV – Mean Corpuscular (Cell) Volume
MCH – Mean Corpuscular (Cell) Hemoglobin
MCHC – Mean Corpuscular (Cell) Hemoglobin Concentration
RDW – Red Cell Distribution Width
HEMOGLOBIN (HGB) g/dLDirect measurement of blood’s oxygen carrying capacity
Can be falsely increased by hemolysis, lipemia and Heinz bodies
Directly measured by instrument
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HCT/PCV %
HCT on analyzer is a calculation
(MCV x RBC) / 10
• Use H:H to check for accuracy of HCT. Hemoglobin: Hematocrit ratio
Hgb x 3 = Hct (within a margin of 4%)
Hgb = 16.2 16.2 x 3 = 48.6 HCT = 46.8%
• INCREASED H:H RATIO GENERALLY CAUSED BY HEMOLYSIS OR LIPEMIA
• LIPEMIA AND HEMOLYSIS MAY FALSELY INCREASE Hgb AND RBC INDICIES
• RECALCULATE MCHC USING SPUN PCV
MCV (fL)
Mean Corpuscular Volume – Average size of single RBC
MCV is directly measured by analyzer.
MCV can be determined indirectly by calculation but it tends to be less accurate.
(HCT x 10) / RBC = MCV
(46.8 x 10) / 6.63 = 70.6
Increased MCV – Macrocytosis
Decreased MCV - Microcytosis
MCH (pg)
Mean Corpuscular Hemoglobin – Average amount of Hgb inside average RBC
(Hgb x 10) / RBC = MCH
MCH provides no added value because the interpretation of the anemia depends on the MCV and MCHC
MCHC (g/dL)
Mean corpuscular hemoglobin concentration – Average Hgbconcentration within RBCs
(Hgb / Hct) x 100 = MCHC
(16.2 / 46.8) x 100 = 34.6
Increased MCHC values are artifact generally caused by lipemia, hemolysis and presence of Heinz bodies.
•Normal MCHC – Normochromic
•Decreased MCHC - Hypochromic
MORPHOLOGIC ANEMIA CLASSIFICATION
•Normocytic normochromic
� Chronic renal disease
•Macrocytic hypochromic
� Regenerative anemias with marked reticulocytosis
•Macrocytic normochromic
� Regenerative anemias
� FeLV
•Microcytic normochromic/hypochromic
� Chronic iron deficiency
� Portosystemic shunt
RDW %
RBC distribution width – amount of variation in size of RBCs
Anisocytosis (Size)
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REFERENCE RANGES (from University of Illinois Veterinary Diagnostic Laboratory)
TEST UNITS CANINE FELINE
HCT % 35 – 52 30 – 45
HEMOGLOBIN g/dL 12 – 18 8 – 15
RBC COUNT x106 5.5 – 8.5 5 – 10
MCV fL 60 – 77 39 – 55
MCH pg 20 – 25 13 – 18
MCHC g/dL 32 – 36 30 – 36
WBC COUNT x103 6.0 – 17.0 5.5 – 19.5
NEUTROPHIL/SEG x103 3.0 – 11.5 2.5 – 12.5
BANDS x103 0.0 – 0.3 0.0 – 0.3
LYMPHOCYTE x103 1.0 – 4.8 1.7 – 7.0
MONOCYTE x103 0.2 – 1.4 0.0 – 0.9
EOSINOPHIL x103 0.1 – 1.0 0.0 – 0.8
BASOPHIL x103 0.0 – 0.2 0.0 – 0.2
PLATELET COUNT x103 200 - 900 300 - 700
SLIDE REVIEW
•Wipe slide clean
•Let blood drop spread across spreader slide
•Do not lift spreader slide
•If HCT is high, decrease angle of spreader slide
•If HCT is low, increase angle of spreader slide
SLIDE REVIEW*ALWAYS SCAN FEATHERED EDGE FIRSTALWAYS SCAN FEATHERED EDGE FIRSTALWAYS SCAN FEATHERED EDGE FIRSTALWAYS SCAN FEATHERED EDGE FIRST
SLIDE REVIEWDIFFERENTIAL
CANINE FELINE
SLIDE REVIEWPLATELETS
NORMAL FELINE PLATELETSNORMAL CANINE PLATELETS
SLIDE REVIEWPLATELETS
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SLIDE REVIEWPLATELETS
Canine
Platelet count = 0.0
SLIDE REVIEWPLATELETS
CALCULATING PLATELET ESTIMATE
COUNT AMOUNT OF PLATELETS SEEN ON 10 VIEWS USING 100X OIF
TAKE AVERAGE OF COUNTED PLATELETS AND MULTIPLY BY 15,000 – 20,000
Ex. – COUNTED 104 PLATELETS TOTAL ON 10 VIEWS
104/10 = 10.4 10.4 X 20,000 = 208,000 (208k)
NOTE IF CLUMPS SEEN (RARE, FEW, MODERATE, MANY)
NOTE IF LARGE PLATELETS SEEN (RARE, FEW, MODERATE, MANY)
WBC COUNTABSOLUTE VS. RELATIVE
WBC DIFFERENTIAL RELATIVE VALUES ARE THE % OF EACH TYPE OF WBC COUNTED
WBC DIFFERENTIAL ABSOLUTE VALUE IS THE % MULTIPLIED BY THE WBC COUNT
CANINE WBC COUNT = 10.1 K/ul
RELATIVE VALUE ABSOLUTE VALUE
NEUTROPHIL 60% 0.6 X 10.1 = 6.06 K/uL
LYMPHOCYTE 24% 0.24 X 10.1 = 2.42 K/uL
MONOCYTE 10% 0.1 X 10.1 = 1.01 K/uL
EOSINOPHIL 6% 0.06 X 10.1 = 0.61 K/uL
BASOPHIL 0%
WBC COUNTABSOLUTE VS. RELATIVE
WBC COUNT = 2.5 K/ul
RELATIVE VALUE ABSOLUTE VALUE
NEUTROPHIL 15% 0.15 X 2.5 = 300 uL
LYMPHOCYTE 80% 0.8 X 2.5 = 1,600 ul
•NEUTROPENIA
•RELATIVE LYMPHOCYTOSIS DUE TO NEUTROPENIA
•NOT ABSOLUTE LYMPHOCYTOSIS
WBCNEUTROPHILS
WBCHYPERSEGMENTED NEUTROPHILS
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WBCTOXIC NEUTROPHILS
WBCBAND NEUTROPHIL
WBCBAND NEUTROPHILS
•A left shift is an increase in number of immature neutrophils
•Most common cause of a left shift is inflammation
•Regenerative left shift – mature neutrophils outnumber bands
•Degenerative left shift – bands/immature neutrophils outnumber mature
WBCLYMPHOCYTES
WBCLYMPHOCYTES
Reactive lymphocyte – cytoplasmic basophilia
Atypical lymphocyte – increased cytoplasmic volume
WBCLYMPHOBLAST
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WBCMONOCYTES
WBC EOSINOPHILS
Canine Feline Degranulated
WBCBASOPHILS
CANINE FELINE
MAST CELLS
RBC Normal FelineNormal Canine
RBCPolychromatophil & nRBC
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RBC
POLYCHROMATOPHILS RETICULOCYTES
RBCHeinz Bodies
RBCHeinz Bodies
New Methylene Blue
RBC
Echinocyte Echinocyte
RBC
Acanthocyte Keratocyte
RBC
Target Cell Ovalocyte
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RBCHypochromic Cell Torocyte
RBC
Spherocytes Howell Jolly Body
RBC
Rouleaux Agglutination
SMUDGED RBCs
RBCSCHISTOCYTE
POLYCHROMATOPHILS
1+ 2+ 3+ 4+
Canine 2-7 8-14 15-29 >30
Feline 1-2 3-8 9-15 >15
Bovine/Porcine 2-5 6-10 11-20 >20
Equine Rarely
observed
All other morphology
Rare Few 1+ 25% 2+ 50% 3+ 75% 4+ 100%
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CASE REVIEW13 yo F/S Persian presented for anorexia and lethargy
mm = pale pink, depressed; other vitals= WNL
CBC on analyzer
WBC – 13.1 RBC – 7.06 M/Ul
Neu – 80% HGB – 11.2 g/dL
Lymph – 15% HCT – 33.6%
Mono – 3% MCV – 47.6 fL
Eos – 0% MCHC – 33.4 g/dL
Baso – 2% RDW – 19.3%
Platelets – 32.0
CASE REVIEW
CASE REVIEW CASE REVIEW
CASE REVIEWDifferential
Neut – 27%
Lymph – 6%
Mono – 0%
Eos – 1%
Baso – 0%
Blasts – 66%
Platelet est – 120K /uL
Rare giant platelet
Pathologist review - The blasts have eccentrically-placed, primarily round nuclei with stippled chromatin and prominent nucleoli, with a small rim of deeply basophilic cytoplasm that rarely contains few small discrete vacuoles. These blasts appear lymphoid (which can be confirmed with flow cytometry or ICC on unstained blood smears). Differentials include acute leukemia (likely lymphoid, less likely erythroid), and stage 5 lymphoma (if other tissues are involved). AU 11-14-16
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